Exploring gastric pH and Helicobacter pylori infection in relation to gastric mucosal lesions

Abstract Background Human gastric juice is a promising source of biomarkers for gastric cancer owing to its content of biologically active compounds, including hydrochloric acid. Helicobacter pylori infection significantly alters gastric acid secretion, leading to hypochlorhydria and atrophic gastritis, a key step in gastric carcinogenesis. However, data on the relationship between gastric acidity, Helicobacter pylori infection, and lesion severity in North African populations remain scarce. This study, conducted between June 2024 and February 2026 and received ethical approval (CE/UM6SS/18/24), aimed to explore the association of Helicobacter pylori infection and gastric acid secretion throughout precancerous gastric lesions in a Moroccan cohort. Methods Gastric biopsies from antrum and fundus and gastric juice were collected from 111 patients referred by gastrologists to perform an upper endoscopy at University Hospital Ibn Rochd, Casablanca. Gastric juice was transported in sterile containers and biopsies in sterile physiological water for DNA extraction and formalin for histopathological examination. Demographic data were collected, gastric lesions were assessed from histopathological examination using the Updated Sydney System, H. pylori infection was detected by PCR targeting ureC gene. Gastric juice pH levels were measured using a pH meter to evaluate acid output. Results verall, 72.97% of patients were infected, the pathological review of gastric biopsies revealed that 60.7% subjects had chronic gastritis, 30.3% had atrophic gastritis and 9% intestinal metaplasia. In univariable analysis, infection was significantly associated with smoking ( p = 0.044), drinking water ( p = 0.047) and gastric lesions ( p = 0.029). However, i, multivariable model, only mineral water (ORa = 0.24, p = 0.015), smoked meat (ORa = 3.74, p = 0.041) remained associated with infection. Regarding gastric acidity, although 77.78% of patients with intestinal metaplasia had a pH > 3 compared to 62.5% in chronic gastritis, this trend did not reach significance ( p = 0.499). Mineral water was the only factor significantly associated with lower pH (ORa = 0.34, p = 0.033). Conclusion while H. pylori infection is highly prevalent, its observed associations with gastric lesions and pH variations were not statistically significant after adjustment for confounders. These findings require larger studies to clarify the relationship between these variables.